Letter to the Editor: Arthroscopic Stabilization of Neer Type 2 Fracture is Not Necessary.

I read with interest the Technical Note by Nourissat et al. in the June 2007 issue regarding arthroscopic stabilization of Neer type 2 fractures of the distal part of the clavicle. Reading the paper in detail, the authors describe in the technical procedure that they make a 2-cm incision perpendicular to the clavicular fracture and perform a suture fixation of the fracture as I described in 2003. This usually will be sufficient for fixation of this particular type of fracture. I see no reason why the authors have advised turning a simple procedure into a very complex and risky one by involving an arthroscopic-assisted coracoid fixation, which is unnecessary in this type of fracture. The exposure in their technique is similar to the exposure in my technique. The technique described by the authors does not reduce the “invasiveness” of the procedure but, on the contrary, unnecessarily increases the risk. By adding the arthroscopic-assisted coracoid fixation, there is substantially increased surgical risk to the neurovascular structures of the brachial nervous plexus and the blood vessels that are lying closed, medial to the coracoid process I understand that by performing an arthroscopic-assisted coracoid fixation, the title “arthroscopic procedure” can be added to this simple mini-open procedure, but it also adds much more complexity and risk to the patient.

(Arthroscopy: 24;2, 2008: p 247)